Using artificial nipples to save BFing?

[Mosaic]

Anyone BTDT?

DD is 4 weeks old, and after midwives, RNs, 2 LCs and an ENT, we're now working through latch issues with a LC/clinical speech pathologist/oral myofunctional disorder specialist. DD was tongue-tied and had tongue mobility problems as well as virtually no sucking strength, so we're working through therapy to get nursing on track.

Our current therapy plan includes starting each feed with a bottle, followed by nursing with a nipple shield, then pacifier and finger exercises/tongue massages in between feeds.

As a result, at this point DD has zero contact with natural nipples. I trust the specialist and her recommendations; but I'm wondering if there's anyone out there who has done something similar and gone on to have a happy, normal breastfeeding relationship?

I always heard that artificial nipples so early can doom a nursing relationship, but here I am relying on them to save it.

[ewe+lamb]

Have you voiced your concerns with your LC/specialist? At over 4 weeks I would like to see at least some contact with a breast, talk over using a Lact-aid with expressed breast milk - I presume your bottles have expressed breastmilk in them, using the biological nurturing position (www.biologicalnurturing.com) which is run by a IBCLC and LLL Leader is London, it also depends on how tongue tied your dd was, I presume it's been clipped, the tongue is a muscle and needs the exercise as it gets used to its freedom - I'm sure you know all this, why is there pacifier use? the sucking on a pacifier is completely different to a breast, i.e. at the front of the mouth just behind the gums in comparison to just where the hard and soft palate meet when breastfeeding - I'm going to contact some other folk I know and see if I can find out more about using a pacifier to induce breastfeeding success - thats where I hesitate just can't get that one - anyway I'll post again.

[ewe+lamb]

Hi - back again - here is something I received from a friend of mine, LC and LLL Leader, she confirms that the pacifier and bottle use is slightly iffy - anyway here's her reply - it may be of some help to you.


"Personally, like you, I would prefer ALWAYS fingerfeeding with a DAL to bottle feeding. Bottle feeding in NO way resembles breastfeeding, and lots of stimulation (pulling back on the finger to encourage a stronger suck, for example) can be done at the same time. And when baby masters feeding like this, the transfer to the breast is easier than with a bottle. She should do a lot of skin to skin holding when fingerfeeding so the association to breast is there.

Re: use of nipple shields.... I have had many moms use them for various reasons from the clinic experience on, and it takes from 2 - 3 weeks to wean them off to the breast. Have faith!! It probably was never necessary (finger feeding would have been better, but everyone thinks first of nipple shields! The problem is that very often the production decreases and the letdowns are not the same either.)

Of course, a great pump and ample supply produced is the MOST important!!! Medela Symphony, double pumping 6 - 8 times a day! (15 mn). Work, but necessary!

Sometimes a baby might take months to be fully capable of keeping up her own supply. I think of a mother, who had to pump 2 - 3 times a day, used a DAL, and her baby took until 9 months to be capable of keeping up her own supply!! She wonders if she would do it again, but knowing her, she would. That was the "worst" case I've ever heard of. Her baby nursed for years, tandem nursing with baby #5 as well.I think her problem was a very weird fat tongue and a very high palate. It took a long time to change these structures, but they DID change!! Her tongue actually became longer and pointy!! "

I hope that this can help you some, if you have any other ???s please don't hesitate to post again.

[Mosaic]

Thanks, ewe... all of this info is very helpful and gives me more to ask the SLP about.

Yes, the tongue-tie was clipped, but her mobility is still restricted. Her tongue stays flat and doesn't cup or elevate much at all. We went back to the ENT for a second evaluation, but she said it's clipped back the the muscle and wouldn't recommend clipping any more. DD's palate is high, and even after finger exercises there is a bump at the back and she pushes things out of her mouth. As a result, her latch is SUPER shallow. So my understanding is that the first challenge is to desensitize the back of her tongue and train it down and forward so that she can properly draw the nipple in.

The other issue is that she was using her jaw to compress the milk out; she wasn't sucking. So the second challenge is to teach her to have a good, strong suck and graded jaw movement. We've continued the finger exercises but have seen better results with the paci and bottle. This article sounds a lot like what we're doing (the exception being that we are working our way up to latex nipples which are harder intentionally to keep her from compressing the milk out). What little I know about finger feeding makes me think that it wouldn't work for us right now because her suck/latch is so bad... is that right?

I'm confused, then, about what's happening when she's at the breast. The shield is filled with milk and she is swallowing, so in this case is bfing with the shield actually more effective at stimulating supply than the shallow latch and compression nursing we'd have without the shield? Also, I'm pumping so that she can have expressed milk for the bottle training; but should I pump more and add more sessions because it sounds like the nipple shield is going to impact my supply as well?

[ewe+lamb]

Hi sorry it took a while to reply - I wanted to read the article and last night I was just too tired, I understand the reasoning behind this BUT at the same time it is rather distanced from breastfeeding still, but that's JMPO so if you're keeping with this then I would suggest doing the bottlefeeding skin to skin so that there is at least some association with the skin/breast.

As for the finger exercises - these things take time - the worst case we've had was 9 months to resolve the problem and maintain a good supply without supplements, don't give up - it will eventually work it just takes perseverance!! You can keep rotating dummy and finger so that she gets used to both and has at least the feel of skin in her mouth, with the warmth, softness etc. I presume that you can carry her in a wrap or sling you could do this topless in the house so that she's getting used to that feeling that you think she's missing - it may encourage her to take the breast a little. Did I mention www.biologicalnurturing.com we've used this technique and had great success even when a baby at 6 months has never taken the breast and only had bottles etc and breastfed - it's a long road but wonderful achievement and feeling for everyone involved.

It's true, in my experience, that nipple shields do reduce the supply of breast milk, but if it's working for you then don't knock it - I also think that techniques used here in europe differ to those in the States, as regards pumping - if you can fit in a few extra sessions great - it'll do no harm, do everything that you can do but also you need to give yourself time to be you and be with your baby, I think I would recommend something like pumping at the same time as nursing so that the breast which the baby is nursing at has a better supply - therefore encouraging the baby to suck a little more, starting off with the nipple shield and then slowly reducing the amount of time of nursing with it - this is just what I think I would recommend and am in no way suggesting that this is what you SHOULD do, but maybe having a few other tricks up your sleeve could help you work things out, this is what I've done with other mothers but I'm not sure that I've ever had a case as severe as yours, so sort of going out on a limb here.

Finally, I think you're doing a fantastic job, the dedication to your child is immense - and stronger even when the odds are down - you are truly wonderful, keep it up and if you need anything else please do not hesitate to post again, I'll keep looking into things for you to see if I can find more solutions for you.

[Megan73]

NOT a professional but can I mention a few things that helped me with my challenging nursling?
First, a SNS can work really well with a shield. I don't know enough about your particular situation, but I don't see how a shield with a SNS (or finger-feeding with a SNS) would be different than a bottle.
My IBCLC told me that if you use a shield and have even borderline supply you must pump after every feed. I used a shield briefly but have definite low supply so I used a hospital-grade pump after every feed for five months. It was a PIA but I really credit it with getting what supply I had well established.
Hang in there, mama, it's sounds like you're doing SO well.

[lettuceknit]

Yes, i had to use a nipple sheild with my first son, due to the fact that i had inverted nipples.

We went on to have a wonderful nursing relationship au natural until he was 2 1/2! It can be done, i feel at this point the most important thing is getting the breast milk into the baby.

i've often wondered why nipple sheild's have such a bad reputations! they saved my breastfeeding career for sure - good luck!

megan

[ians_mommy]

I used a nipple shield with my firstborn for 8 months and he went on to BF for 20 motnhs total. I never had a supply issue.
I used them for the first 6 weeks of this LOs life (just ditched them this week). I have so much milk that I have to pump for comfort (she doesnt eat as much as Mommy makes).
My only issue with the shields is it makes NIP a little more ackward and when I stop using them I get nipple soreness for the first week or so...nothing some cool packs and motrin doesnt fix.

[CBall]

I wanted to comment on the the nipple shields. While they are not the optimal method, sometimes I think they get a bad rap. I almost gave up breastfeeding all together because of my babies latch issues and a 1/4 in ( i'm not kidding) bloody crack on my nipple. I was terrified of trying the nipple shields because of maybe having a supply/nipple shield addiction issue. Fast forward 5 months later. While I'm still using the nipple shield, I've never had a supply issue. My daughter is EBF and has never had a bottle in her life. Yeah they are a pain to keep clean, it's extra stuff to carry, and I have to use a nursing cover. But big whoop, we are still nursing when most of my friends with babies have stopped. If it comes down to giving up nursing or exclusively pumping I'd go with the shield. I still get to have that connection with my daughter and she's still getting just my milk. Hope everything works out.

[emilysmama]

My dd did not learn to latch on for the first 3 months of her life. One of the most helpful things we used was a Haberman Feeder, which is a special type of bottle that helps develop sucking strength and will not develop nipple confusion. (We also used an SNS and nipple shields and a lot of pumping, but none of them would have worked had we not used the Haberman Feeder.) Dd went on to nurse until she stopped by herself at the age of 3 years old.